Becker’s Healthcare Podcast: Interview with James Siegel, SVP & CFO of VCU Health
Release Date: November 1, 2025
Host: Madeline Ashley, Becker's Healthcare
Guest: James Siegel, Senior Vice President & Chief Financial Officer, VCU Health
Episode Overview
In this episode, Madeline Ashley speaks with James Siegel, SVP and CFO of VCU Health, about navigating ongoing industry changes, financial leadership during uncertainty, VCU Health’s current growth and expansion strategies, and the system’s ambitious performance improvement initiative, Thrive 2026. Siegel provides practical insights into handling regulatory unpredictability and shares advice for other health systems seeking to expand ambulatory operations.
Key Discussion Points & Insights
1. VCU Health Overview
- [00:27] Siegel introduces VCU Health as:
- The premier academic medical center in downtown Richmond, VA
- Total of nearly 890 beds across flagship and community hospitals
- Over $4 billion in operating revenue, 1.3 million outpatient visits, 14,000+ employees, and a comprehensive provider team
“All in we’re about $4 billion in total operating revenue, about 48,000 discharges, ... over 14,000 team members, over a thousand physicians, and 700 plus advanced practice professionals. So a very comprehensive, integrated academic health system.” – James Siegel [00:27]
2. Top Industry Trends & Legislative Uncertainty
- [01:53] Siegel discusses key trends, with focus on legislative impacts:
- “One Big Beautiful Bill Act” and its potential ripple effects (Medicaid changes, ACA tax credits expiration, 340B, site neutrality)
- Scenario planning is ongoing but complicated by unknown timing and state responses
- Recognition that navigating regulatory uncertainty is enduring in healthcare
"We know there will be impact and we are measuring those impacts and they could be material. … We don't know what the timing of some of these changes will be. … These types of impacts to healthcare are not new." – James Siegel [01:53]
3. Leadership in Uncertain Times
- [04:24] Financial strategy during change:
- Building on lessons learned from COVID-19
- Emphasis on performance improvement that is sustainable, not just temporary
- Launch of “Thrive 2026” initiative integrating cross-functional leadership and frontline clinicians
"What we've done as we ended our fourth quarter of our FY25 ... we stood up what we call Thrive 2026 … to navigate the challenges that are on the horizon and really get to a strong operating margin performance and a sustainable operating EBITDA performance." – James Siegel [04:24]
4. ‘Thrive 2026’ Performance Improvement Initiative
- [05:59] Purpose and structure:
- All-hands-on-deck program led by senior leadership, with 9 performance improvement teams
- Focus areas: inpatient efficiency, outpatient access, expense management, clinical transformation
- Clinicians and administrative leaders work together for front-line insights
“We've also invited our chairs, our clinical chairs into Thrive 2026. … They are front and center with administrators and operators to drive ... that sustainable performance improvement.” – James Siegel [06:15]
5. Growth, Investments, and Expansion Strategy
- [07:23] Recent and ongoing investments:
- Opening of a 615,000-square-foot adult outpatient pavilion for cancer and specialty services
- Expansion with ambulatory surgery centers in Richmond suburbs (Henrico/Short Pump)
- New Children’s Hospital of Richmond (opened April 2023): major growth in pediatric care metrics
- Dedicated liver care unit: serving rising national transplant needs; 18% increase in organ transplants
- Early U.S. adoption of robotic living donor liver transplants and first successful lung transplant in 2024
- System-wide investments drive nearly 12% compound annual revenue growth since 2021
"We actually performed the first robotic living donor liver transplant in the United States earlier in 2025. ... All of these investments have continued to contribute to VCU Health achieving a compound annual growth rate in terms of revenue growth since 2021 of almost 12%." – James Siegel [09:20, 10:33]
6. Looking Ahead: Planned Expansions
- [10:59] Strategic projects through 2027:
- New ambulatory surgery center & medical office in Chesterfield (opening 2027)
- Expansion of Children’s Hospital: 20 more neonatal intensive care beds by 2026, 24 additional acute beds by 2027
- Scaling infrastructure to anticipate future regional demand
7. Priority on Ambulatory Growth
- [12:24] Why expand ambulatory services?
- Mission to extend high-acuity specialty care closer to patients’ communities
- Reduced need for travel downtown; meeting patients where they are
“We want to bring that level of care out into the community in an ambulatory setting. ... The community demands that level of care and we want to bring it to where they live, not asking them to always come downtown.” – James Siegel [12:24]
8. Advice for Systems Entering Ambulatory Growth
- [13:17] Siegel’s practical advice:
- Prioritize convenience (physical locations, digital access through EHR/myChart)
- Today’s patients expect ease of access—health systems must adapt to a “point and click” reality
“Convenience comes in a variety of ways, bricks and mortar in the community. … Today's patients are very savvy and they're used to a point and click environment. And you have to deliver care in some ways, even though it's very complicated care delivery, you have to make it easier and easy for the patients to access.” – James Siegel [13:17]
Notable Quotes & Memorable Moments
- “Sustainability is really the key here in terms of what Thrive 2026 is all about.” – James Siegel [04:52]
- “Some of the most critical services that VCU Health provides—transplant, orthopedics, cancer, etc.—all of these investments have contributed to fantastic growth…” – James Siegel [09:58]
- “If you can’t make it easy to access and they can’t get in your front door, today’s patients are very savvy and ... you have to make it easier and easy for the patients to access.” – James Siegel [13:29]
Timestamps for Key Segments
- 00:27: Siegel introduces VCU Health and his role
- 01:53: Current legislative and industry trends
- 04:24: Financial leadership and launch of Thrive 2026
- 05:59: Deep dive into Thrive 2026 program and governance
- 07:23: Major growth projects and investment highlights
- 10:59: Future growth plans and capacity expansions
- 12:24: Rationale for ambulatory care expansion
- 13:17: Advice for other systems expanding ambulatory access
Summary
This episode offers a rich look inside VCU Health’s strategic responses to healthcare’s evolving landscape. James Siegel shares both high-level strategy and actionable advice, emphasizing sustainable improvement, the patient-centric expansion of specialty care, and the crucial role of high-functioning, collaborative leadership. With ambitious capital projects underway and strong recent growth, VCU Health positions itself as a forward-thinking system actively shaping its future amidst industry complexity.